Provider Demographics
NPI:1134192560
Name:MAHAJAN, RAKA (MD)
Entity type:Individual
Prefix:
First Name:RAKA
Middle Name:
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:23500 PARK ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2598
Mailing Address - Country:US
Mailing Address - Phone:313-292-3500
Mailing Address - Fax:313-292-3503
Practice Address - Street 1:23500 PARK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2598
Practice Address - Country:US
Practice Address - Phone:313-292-3500
Practice Address - Fax:313-292-3503
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRM043153207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108224641OtherBLUE CROSS BLUE SHIELD
MI1566855Medicaid
MI019394OtherMIDWEST HEALTH
MN110167981OtherTRAVELERS MEDICARE
MIC3278OtherMCARE
MI000000003118OtherCAPE HEALTH
MN110167981OtherTRAVELERS MEDICARE
MIB45910Medicare UPIN